Provider Demographics
NPI:1790942993
Name:JAMIL, SAWSAN WADI (MD)
Entity Type:Individual
Prefix:DR
First Name:SAWSAN
Middle Name:WADI
Last Name:JAMIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SAWSAN
Other - Middle Name:WADI
Other - Last Name:SHUKRI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11012 E 13 MILE RD STE 212
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2547
Mailing Address - Country:US
Mailing Address - Phone:586-582-7150
Mailing Address - Fax:586-582-7164
Practice Address - Street 1:11012 E 13 MILE RD STE 212
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2547
Practice Address - Country:US
Practice Address - Phone:586-582-7150
Practice Address - Fax:586-582-7164
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090183207V00000X
CAA113660207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology